This patient presented with a painful, pale, paraesthetic, pulseless, perishingly cold hand.
They were found to be in atrial fibrillation.
This longitudinal view of the brachial artery shows thrombus within the lumen. It is wedged just proximal to the point of bifurcation into radial and ulnar arteries and can be seen to move with each heart beat.
Arterial embolism into the upper limb vessels is not uncommon. Thrombus tends to lodge at point of vessel bifurcation as occurred here.
This patient underwent successful thrombectomy and has had no further problems since anticoagulation was commenced.